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Inefficiency Hurts U.S. in Longevity Rankings

By any measure, the United States spends more on health care than any other nation. Yet according to the World Fact Book (published by the Central Intelligence Agency), it ranks 49th in life expectancy.

Peter A. Muennig and Sherry A. Glied, researchers at the Mailman School of Public Health at Columbia University, compared the performance of the United States and 12 other industrialized nations: Australia, Austria, Belgium, Britain, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden and Switzerland. In addition to health care expenditures in each country, they focused on two other important statistics: 15-year survival for people at 45 years and for those at 65 years.

The researchers say those numbers present an accurate picture of public health because they measure a country’s success in preventing and treating the most common causes of death — cardiovascular disease, stroke and diabetes — which are more likely to occur at these ages. Their data come from the World Health Organization and cover 1975 to 2005.

In 1975 the United States was close to the average in health care costs, and last in 15-year survival for 45-year-old men. By 2005 its costs had more than tripled, far surpassing increases elsewhere, but the survival number was still last — a little over 90 percent, compared with more than 94 percent for Swedes, Swiss and Australians. For women, it was 94 percent in the United States, versus 97 percent in Switzerland, Australia and Japan.

The numbers for 65-year-olds in 2005 were similar: about 58 percent of American men could be expected to survive 15 years, compared with more than 65 percent of Australians, Japanese and Swiss. While more than 80 percent of 65-year-old women in France, Switzerland, and Japan would survive 15 years, only about 70 percent of American women could be expected to live that long.

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In narrowing the blame to the American health care system, the researchers first eliminated several other factors. Obesity and smoking are the most important behavior-related causes of death, but obesity increased more slowly in the United States than in the other countries and smoking declined more rapidly, so neither can explain the differences in survival rates. Homicide and traffic fatality rates have remained steady over time, and social, economic and educational factors do not vary greatly among these countries.

But not all experts agree with this analysis. Samuel Preston, a demographer and a professor of sociology at the University of Pennsylvania, says the analysis is faulty.

“The basic message is correct — that measures of U.S. health, including mortality and morbidity, are very poor in comparison with other countries,” he said. But the Columbia researchers “have no direct evidence about the health care system in this article,” he continued. “Their conclusion is extremely speculative.”

That they did not find smoking at fault, Dr. Preston said, “is mysterious to me, particularly since they show high lung cancer mortality for the U.S.” Dr. Preston has published widely on mortality trends and the effects of smoking.

Dr. Muennig conceded that the study examined only life expectancy and health care spending in the 13 countries, and not the structure or economics of health care. “We did a pretty good job of showing that smoking isn’t the culprit,” he said.

“Smoking and obesity are still major risk factors for an individual’s health,” he said. “But they are sapping life expectancy in all countries. Whereas in the U.S. we have a highly inefficient health system that’s taking away financial resources from other lifesaving programs.”

Correction: December 1, 2010

An article on Tuesday about life expectancy in the United States misstated the name of the journal in which researchers reported that inefficiencies in the health care system were to blame for the country’s poor ranking compared with other industrialized nations. It is Health Affairs, not Health Services. The article also misspelled the surname of one of the researchers. She is Sherry A. Glied, not Gleid.

A version of this article appears in print on November 30, 2010, on Page D5 of the New York edition with the headline: Inefficiency Hurts U.S. In Ranking Of Health. Order Reprints|Today's Paper|Subscribe